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Two months to go on congenital heart disease consultation, and still no answers

3 April 2017

At a consultation event for staff at Royal Brompton Hospital on Friday (31 March), NHS England claimed their proposals to decommission congenital heart disease (CHD) services from the Trust had the backing of clinicians … but were unable to arrange for a single doctor to attend the meeting and defend the proposals.

The NHS England panel, managers Will Huxter, regional director for specialised commissioning, and Sue Sawyer, regional programme of care manager for internal medicine, faced questioning from doctors, nurses, physiotherapists and other allied health professionals from across the Trust.

The event was another chance for NHS England to provide evidence in support of its new ‘co-location’ standard for CHD services, the one standard out of 470 which it claims Royal Brompton does not meet. No centre in the country meets them all.

But, despite NHS England representatives having had weeks of preparation time to provide evidence to support the benefits of co-location, they were again unable to.

The co-location standard requires certain paediatric services, such as gastroenterology and general surgery, to be ‘co-located’ in the same building as the CHD service. As a specialist heart and lung hospital, Royal Brompton delivers a co-located paediatric service in partnership with neighbouring Chelsea and Westminster hospital, just a few minutes’ walk away.

The inconsistency of the standards

Dr Jan Till, co-director of children’s services and consultant paediatric electrophysiologist, opened the meeting by asking: “What is it exactly that you think our patients are lacking?”

The panel was unable to name any single aspect of care, or cite any deficiency in quality of service, that the Trust’s patients receive. In fact, Will Huxter admitted “We don’t have concerns about CHD outcomes – in fact they’re very good across the country.”

The panel was then pressed on why Evelina Hospital in Westminster – which only has access to on-call gastroenterology through an arrangement with Kings College Hospital three miles away – was deemed to meet the co-location standard, but the Trust’s arrangements with neighbouring Chelsea & Westminster Hospital, half a mile away, was not.

A waste of resources and a threat to research

Mr Babulal Sethia, consultant cardiac surgeon and president of the Royal Society of Medicine, asked Will Huxter: “Professor Huon Gray [NHS England’s national clinical director for heart disease] admitted at the last meeting that there was no evidence to support the co-location of paediatric services. If this consultation process is a charade, what is the cost of this charade, and how do you justify wasting this much money when resources are stretched in the NHS?”

Professor Michael Gatzoulis, consultant cardiologist and professor of cardiology, and congenital heart disease at the National Heart and Lung Institute, Imperial College London, said: “We have the largest training programme for adult CHD in the world. Our research is clinical, it’s not based in a laboratory. Our work at Royal Brompton has transformed patient care in the UK and the rest of the world. Would you now accept that it would have an adverse impact on research, and therefore an immediate impact on patient care, which is the very thing you are trying to improve?”

Despite repeated opportunities to do so, the NHS England panel were unable to provide answers.

Inadequate consultation

Staff at the Trust also lambasted NHS England’s official consultation document. The document does not provide evidence on how their proposals would improve care for patients, any explanation of the risks involved in transferring people’s care to other providers, any detail of the impact for the Trust’s paediatric respiratory patients, or on protecting influential CHD research.

Several staff also suggested NHS England had a very complacent attitude to staffing – suggesting that congenital heart teams would be happy to disband and transfer to other hospitals if the proposals went ahead.

Commenting on the meeting, medical director Dr Richard Grocott-Mason said: “The lack of clinical representation from NHS England was very telling. Time and time again we’ve been told that their plans have clinical support, yet they could not arrange for a single medical representative to come and speak directly to our staff.

“It’s extremely disappointing – this was the main consultation event for the teams at Royal Brompton who would be directly affected by these proposals, and over a hundred clinical staff gave up their valuable time to take part in discussions. NHS England has identified staffing as one of the main risks in their proposals, yet they did not come prepared for a full conversation.

“As a doctor, I cannot understand how NHS England’s plan would result in patients receiving better care. It makes no sense to try and improve care by closing one of the biggest, well-performing services, or by destroying research teams that are leading the way in finding new treatments for the future.”

Official figures show that Royal Brompton operates the UK’s largest CHD service, and consistently has among the best patient outcomes in the country. Clinical teams help over 12,500 patients, treating many from birth through childhood, adolescence and adulthood. It also has exceptionally high patient satisfaction levels, with over 98 per cent of patients saying that they would recommend the cardiology service. The UK’s CHD services as a whole are already considered to be among the best in the world.